冷冻保存的红细胞优于标准液态红细胞。
Cryopreserved red blood cells are superior to standard liquid red blood cells.
机构信息
From the Oregon Health and Science University, Division of Trauma, Critical Care and Acute Care Surgery, Trauma Research Institute of Oregon (D.A.H., L.J.F., L.K., J.D., S.U., D.L., J.W., M.A.S.); and Portland State University (C.W.),Portland, Oregon.
出版信息
J Trauma Acute Care Surg. 2014 Jul;77(1):20-7; discussion 26-7. doi: 10.1097/TA.0000000000000268.
BACKGROUND
Liquid preserved packed red blood cell (LPRBC) transfusions are used to treat anemia and increase end-organ perfusion. Throughout their storage duration, LPRBCs undergo biochemical and structural changes collectively known as the storage lesion. These changes adversely affect perfusion and oxygen off-loading. Cryopreserved RBCs (CPRBC) can be stored for up to 10 years and potentially minimize the associated storage lesion. We hypothesized that CPRBCs maintain a superior biochemical profile compared with LPRBCs.
METHODS
This was a prospective, randomized, double-blinded study. Adult trauma patients with an Injury Severity Score (ISS) greater than 4 and an anticipated 1-U to 2-U transfusion of PRBCs were eligible. Enrolled patients were randomized to receive either CPRBCs or LPRBCs. Serum proteins (haptoglobin, serum amyloid P, and C-reactive protein), proinflammatory and anti-inflammatory cytokines, d-dimer, nitric oxide, and 2,3-DPG concentrations were analyzed. Mann-Whitney U-test and Wilcoxon rank sum test were used to assess significance (p < 0.05).
RESULTS
Fifty-seven patients were enrolled (CPRBC, n = 22; LPRBC, n = 35). The LPRBC group's final interleukin 8, tumor necrosis factor α, and d-dimer concentrations were elevated compared with their pretransfusion values (p < 0.05). After the second transfused units, 2,3-DPG was higher in the patients receiving CPRBCs (p < 0.05); this difference persisted throughout the study. Finally, serum protein concentrations were decreased in the transfused CPRBC units compared with LPRBC (p < 0.01).
CONCLUSION
CPRBC transfusions have a superior biochemical profile: an absent inflammatory response, attenuated fibrinolytic state, and increased 2,3-DPG. A blood banking system using both storage techniques will offer the highest-quality products to critically injured patients virtually independent of periodic changes in donor availability and transfusion needs.
LEVEL OF EVIDENCE
Therapeutic study, level II.
背景
液体保存的浓缩红细胞（LPRBC）输注用于治疗贫血和增加终末器官灌注。在整个储存期间，LPRBC 会发生生化和结构变化，统称为储存损伤。这些变化会对灌注和氧释放产生不利影响。冷冻保存的红细胞（CPRBC）可以储存长达 10 年，并且可以潜在地最大限度地减少相关的储存损伤。我们假设 CPRBC 比 LPRBC 具有更好的生化特征。
方法
这是一项前瞻性、随机、双盲研究。损伤严重程度评分（ISS）大于 4 分且预计需要输注 1 至 2 单位 PRBC 的成年创伤患者有资格参加。入组患者随机分为接受 CPRBC 或 LPRBC 治疗。分析血清蛋白（触珠蛋白、血清淀粉样蛋白 P 和 C 反应蛋白）、促炎和抗炎细胞因子、D-二聚体、一氧化氮和 2,3-DPG 浓度。Mann-Whitney U 检验和 Wilcoxon 秩和检验用于评估显著性（p<0.05）。
结果
共纳入 57 例患者（CPRBC 组 n=22，LPRBC 组 n=35）。与输注前相比，LPRBC 组的白细胞介素 8、肿瘤坏死因子 α 和 D-二聚体的终末浓度升高（p<0.05）。在输注第二单位后，接受 CPRBC 输注的患者 2,3-DPG 较高（p<0.05）；这种差异在整个研究过程中持续存在。最后，与 LPRBC 相比，输注的 CPRBC 单位中的血清蛋白浓度降低（p<0.01）。
结论
CPRBC 输注具有更好的生化特征：无炎症反应、纤维蛋白溶解状态减弱和 2,3-DPG 增加。使用两种储存技术的血库系统将为危重症患者提供最高质量的产品，几乎与供体可用性和输血需求的周期性变化无关。
证据水平
治疗研究，II 级。
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